Christian doctors' group calls referring patients for assisted death 'morally the same'

The head of the Christian doctors' group that met recently with Manitoba's health minister says doctors with religious or moral objections to physician-assisted dying should not be forced to issue referrals to patients but instead allow patients to switch doctors altogether.

The Christian Medical and Dental Society met with Health Minister Kelvin Goertzen on July 11 to lobby for conscience protection for doctors who object to physician-assisted death.

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The group is also asking Ontario's top court to reverse a provincial government policy requiring physicians to refer patients who want an assisted death to another doctor.

Its stance has prompted debate about what a doctor's responsibility is to a patient who wants to access a medically assisted death, particularly if that doctor has religious or moral objections to the practice.

In Manitoba, physicians are only required to direct patients to a website or phone line with information about assisted dying — something University of Manitoba medical ethicist Arthur Schafer argues is not enough to protect the dignity and rights of patients.

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Larry Worthen, the Christian doctors society's executive director, said while his members have no issue with providing information to patients who ask about medically assisted death, they believe making referrals is "morally the same as actually doing the act itself."

"So for us to be forced to make a referral for this would require us to go against our basic beliefs, our responsibility to God and to our fellow human beings," he said.

The Nova Scotia-based society represents 5,000 doctors and dentists across the country, including 200 from Manitoba.

Worthen spoke with CBC's Information Radio on Friday about his meeting with the provincial government and the society's concerns:

Q: What did you want to tell our health minister?

Just the importance of conscience protection and also that there are ways that we can respect patient decision-making in this matter and also to ensure that conscience protections are met.

Q: Why do you believe Manitoba's position is fair to both patients and doctors?

Every doctor, when faced with a patient who is interested in considering medically aided dying, is going to take time with that patient, they're going to try to determine what the source of the suffering is, they're going to talk to the patient about alternatives and what can be done.

The [College of Physicians and Surgeons of Manitoba] policy only talks about issues mainly related to referral and it simply says that the doctor must offer access to relevant information and to a referral. The Manitoba government has a system in place that would allow that.… There are other alternatives, also, that can be looked at when a patient is unable to use, perhaps, a telephone line or a website.

Q: Why has your organization taken a firm position against doctors making referrals for assisted death?

We've checked this out with ethical experts in the Catholic faith and Evangelical faith [and] amongst Orthodox Jews, and for all of those groups, making a referral is exactly morally the same as actually doing the act itself.

So for us to be forced to make a referral for this would require us to go against our basic beliefs, our responsibility to God and to our fellow human beings. It would be completely alienating; we would feel that we are just not doing the best for our patients, that we're actually betraying that patient.

Q: What would you say to Arthur Schafer and others who are looking at the responsibility of physicians to their patients first, to their patients' rights to die first, as is legislated across the country now?

What I would say is look, we need to be tolerant, we need to consider the interests of minority groups, and we need to consider the interests of patients. It's not in the interest of patients if all of the doctors we represent have to go into sports medicine, as the professor recommends. 

[In an interview last week, Schafer said doctors who are vehemently opposed to physician-assisted death "should be practising in a different branch of medicine or perhaps you shouldn't be practising as a doctor."]

Q: What about patients who are in a vulnerable state or not able to make a phone call or visit a website?

Again, no doctor is going to just hand someone a website address.… I mean, the doctor is concerned about their patient and even though they may disagree, they recognize that the patient makes their own decisions in terms of their health.

So something like a complete transfer of care from the objecting physician to another, willing physician is certainly something that's done regularly. It's something that's definitely an option, and the people in the Department of Health are open to helping to facilitate that, and in suitable cases that could be an alternative.

Q: How is a transfer of care different from a referral?

Our whole approach is that we do this because we believe in God and we believe that God has given an inimitable dignity to every human being, but it wouldn't be right from our faith perspective to force someone to receive services from a particular doctor against their will.

So if a patient decides that this is the direction they want to go in, and they want the doctor to do something that they cannot do by their conscience, then the patient can ask for a transfer of care and it would our expectation that the Department of Health would help facilitate that so that a doctor who did not have a conscientious objection would be able to see the patient.

Once again, we're talking about a complete transfer of care here, not a partial transfer of care, but a complete transfer of care. And the reason we are OK with that is that we believe in the dignity of the patient and we do not believe that anyone should force a patient to be served by a doctor that they have a substantial disagreement with.

Q: What do your members here in Manitoba tell you about how they are wrestling with this issue?

Well, it's very disturbing. I mean, we've had 2,400 years of Hippocratic medicine and now that's been turned on its head. But our members are dealing with patients all the time, every day, that they may not agree with, that they may feel that they're making decisions that go against our moral beliefs.

We're not in the business of preaching to our patients or forcing them to follow our moral beliefs. Every day our doctors deal with patients who disagree on fundamental issues like this. We simply ask that we are able to step back and allow the patient to get their needs met through the Department of Health. We feel it is possible to do that, and we encourage the professor who was on last week to sit down in dialogue with us so that we can find ways through this that meet both the patients' needs and also the needs of conscientious objectors.